Practical Application of High Frequency Positive Pressure Ventilation for Tracheobronchoplasty

In three tracheobronchoplasty operations, we used a special catheter with a cuff for high frequency positive pressure ventilation (HFPPV). Two patients had right sleeve upper lobectomy after left upper lobectomy and one had right sleeve pneumonectomy for primary squamous cell carcinomas of the lung. For the right sleeve upper lobectomies after left upper lobectomy, we performed HFPPV to the right middle and lower lobes combined with manual ventilation of left lower lobe, and for the right sleeve pneumonectomy, we performed HFPPV to the left lung only. There were no problems in pulmonary or systemic circulation, and we were able to achieve good access to the operative site with unimpaired visualization. HFPPV has some problems, such as the choice of catheter, contaminations of the operative field by the catheter and aspiration of blood through the opened bronchus. We used the Univent tracheal tube with open lumen blocker (Fuji systems corp.) with good results, because we could advance the special catheter into the operative field aseptically through the side lumen of the tube, inflate the anastomosed lung with good expansion and prevent the aspiration of blood.